<html>    
	<head>
	<link href="templatemo_style3.css" rel="stylesheet" type="text/css" />
	<link href="styles3.css"rel="stylesheet" media="screen" />
	<link rel="stylesheet" href="Login.css" type="text/css" media="screen" />
	</head>
	<body>
	<div id="templatemo_banner1">
	<div class="header_right">
						<div class="login">
							<a href="Logout.html">LogOut</a>
							<a href="#">Feedback</a>
						</div>		
							<div class="date">			
						<script type="text/javascript">
						document.write ('<p> <span id="date-time">', new Date().toLocaleString(), '<\/span>.<\/p>')
						if(document.getElementById) onload = function () {
							setInterval ("document.getElementById ('date-time').firstChild.data = new Date().toLocaleString()", 50)
						}
						</script>
						
						</div>
				</div>
    <div id="form_button">
    <form class="contact_form" action="./register.html" method="post" name="regform" onsubmit="return submitform();">
    <ul>
   		
			<li>
             <h2>Broker  Registration </h2>
			 
              <span id="required"> * Denotes Required Field</span>
           </li>
		   
		  <li>
			<h4>Company Details</h4>
			<label for="name">Company Name<font color="red" size="3">*</font></label>
			 <input type="name" name="txtname" size="40" placeholder="Compney Name" required/>
          </li>
		        
        <li>
           <label for="number">Mobile Number<font color="red" size="3">*</font></label>
            <input type="text" maxlength="10" name="txtmobno" placeholder="Mobile Number" required />
        </li>
		
		<li>
           <label for="number">Web Address<font color="red" size="3">*</font></label>
            <input type="text" maxlength="20" name="txtweb" size="40" placeholder="www.abc.com" required />
        </li>
		
		<li>
		     <label for="email">Email<font color="red" size="3">*</font></label>
            <input type="email" name="txtemail" size="40" placeholder="john_doe@example.com" required/>
        	 
        </li>
		
		<li>
           <label for="date">Year of Incorporation<font color="red" size="3">*</font></label>
            <input type="text" maxlength="10" name="txtdate" placeholder="01/01/2000" required />
        </li>
		
		<br/>
			
		 <li>
           <label for="pan">Pan Number<font color="red" size="3">*</font></label>
            <input type="text" maxlength="10" name="txtpanno" placeholder="CYGP1554G" required />
        </li>
		
		 <li>
           <label for="pan">Demat Account Number<font color="red" size="3">*</font></label>
            <input type="text" maxlength="10" name="txtdemat" placeholder="BR1234" required />
        </li>
		
		<br/>
		
		<h4>Location Detail </h4>
		
		 <li>
           <label for="address">Address<font color="red" size="3">*</font></label>
		   
		   <textarea rows="2" cols="25"  name="txtaddress"  placeholder="Address" required>
           
			</textarea>
			
			<select name="State">
			<option value="" selected="selected" >---State---</option>
			<option value="state">Maharashtra</option>
			<option value="state">Gujrat</option>
			<option value="state">Delhi</option>
			</select>
			<select name="City">
			<option value="city" selected >---City---</option>
			<option value="mumbai">Mumbai</option>
			<option value="pune">Pune</option>
			</select>
       
        </li>
        	<br/>
		
		<h4>Account Detail</h4>
		<li>
            <label for="Password">Password<font color="red" size="3">*</font></label>
            <input type="password" name="txtpassword" placeholder="Password"  required />
      
        </li> 
		
        <li>
            <label for="Password">Confirm Password<font color="red" size="3">*</font></label>
            <input type="password" name="txtcpassword" placeholder="confirm password" required />
        </li> 
		
        <li>
        	<button class="submit" type="submit">Register</button>
			<button class="reset" type="reset" onclick="reset_msg()">Reset</button>
        </li>
    </ul>
</form>
    </div>
    </div>
	</body>
	</html>